ACUTE CORD REPERFUSION INJURY AFTER POSTERIOR CERVICAL DECOMPRESSION FOR CHRONIC POSTERIOR LONGITUDINAL LIGAMENT OSSIFICATION STENOSIS

A 63-year-old male patient was referred to our outpatient clinic with complaints of upper and lower limbs weakness, which started progressively 5 years ago. Cervical X-ray and magnetic resonance imaging showed straitening of the cervical column in a fixed flexion position and fusion of the vertebral bodies, with diffuse type posterior longitudinal ligament ossification with secondary canal stenosis. The patient was operated with C2-T2 laminectomy. In the immediate post-operative period, the patient was conscious. However, he was unable to breath by himself with insufficient respiratory tidal volume and worsening of the weakness of the extremities. Emergency cervical computed tomography scan showed proper decompression of the cervical canal, no evidence of haemorrhage, and enlarged oedematous spinal cord. The patient was diagnosed of post-decompression reperfusion injury with secondary diaphragm paralysis. Ventilation and medical treatment were applied to manage the situation and the patient improved in his lower limbs motor power and in the tidal volume. The decision was to transfer the patient to another rehabilitation centre to continue treatment.

Kaynakça

Vinodh VP, Rajapathy SK, Sellamuthu P, Kandasamy R. White cord syndrome: A devastating complication of spinal decompression surgery. Surg Neurol Int. 2018,13;9:136.

Chin KR, Seale J, Cumming V. “White Cord Syndrome” of Acute Tetraplegia after Anterior Cervical Decompression and Fusion for Chronic Spinal Cord Compression: A Case Report. Case Rep Orthop. 2013;2013:697918. doi: 10.1155/2013/697918

Pan W, Banks WA, Kastin AJ. Blood-Brain Barrier Permeability to Ebiratide and TNF in Acute Spinal Cord Injury. Exp Neurol. 1997;146:367-73.

Yu F, Kamada H, Niizuma K, Endo H, Chan PH. Induction of MMP9 Expression and Endothelial Injury by Oxidative Stress after Spinal Cord Injury. J Neurotrauma. 2008;25:184-95.

Anik I, Kokturk S, Genc H, Cabuk B, Koc K, Yavuz S, et al. Immunohistochemical analysis of TIMP-2 and collagen types I and IV in experimental spinal cord ischemia-reperfusion injury in rats. J Spinal Cord Med. 2011;34:257-64.

Vidal PM, Karadimas SK, Ulndreaj A, Laliberte AM, Tetreault L, Forner S, et al. Delayed decompression exacerbates ischemia-reperfusion injury in cervical compressive myelopathy. JCI Insight. 2017, 2;2(11). 10.1172/jci.insight.92512

Seichi A, Takeshita K, Kawaguchi H, Nakajima S, Akune T, Nakamura K. Postoperative expansion of intramedullary high-intensity areas on T2-weighted magnetic resonance imaging after cervical laminoplasty. Spine (Phila Pa 1976). 2004;29:1478-82.

Kaplan T, Kafa IM, Cansev M, Bekar A, Karli N, Taskapilioglu MO, et al. Investigation of the dose-dependency of citicoline effects on nerve regeneration and functional recovery in a rat model of sciatic nerve injury. Turk Neurosurg. 2014;24:54-62.

Gella A, Martiañez T, Lamarca A, Gutierrez C, Durany N, Casals N. A nucleotide-based Drug Protects Against Glutamate- and MPP+Induced Neurotoxicity. Neuroscience & Medicine 2011;2:154-60.

Lee JY, Choi HY, Yune TY. Fluoxetine and vitamin C synergistically inhibits blood-spinal cord barrier disruption and improves functional recovery after spinal cord injury. Neuropharmacology. 2016;109:78-87.

Bracken MB, Shepard MJ, Holford TR, Leo-Summers L, Aldrich EF, Fazl M, et al. Administration of Methylprednisolone for 24 or 48 Hours or Tirilazad mesylate for 48 Hours in the Treatment of Acute Spinal Cord Injury. Results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. National acute spinal cord injury study. JAMA 1997;277:1597-604.

Kaynak Göster

828 461

Arşiv